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A Tale of Two Cities: Flawed Epidemiology

In July 2006, Fombonne et al published a
report in PEDIATRICS
about pervasive developmental disorders, MMR vaccination and
Thimerosal.

In a letter to the editor of the journal, I
reported legitimate concerns about the MMR research and its
conclusions.

Both Dr. Fombonne and the editor chose to
ignore them.

***

On February 2, 2007, I re-submitted a
letter to the editor of PEDIATRICS
about a study that had been published on July 6, 2006.

PEDIATRICS
is the journal of the American Academy of Pediatrics (AAP).

I have been a Fellow of the Academy since 1963
and this was the first letter to the editor of the journal I had ever
written.

Following is the exact text of my letter:

Far-Fetched

In “Pervasive developmental
disorders in Montreal, Quebec, Canada: prevalence and links with
immunizations” (1) Fombonne et al reported that in a group of
English-speaking Montreal children born from 1987 to 1998, the
prevalence of pervasive developmental disorders (PDD) was high and
increasing. They also claimed that during the same period,
Measles-mumps-rubella (MMR) vaccination coverage had decreased and
concluded, “Thus, pervasive developmental disorder rates
significantly increased when measles-mumps-rubella vaccination uptake
rates significantly decreased.”

The MMR uptake data used “were
available through N. Bouliane, BN, MSc of the Direction de Santé
Publique de la Capitale Nationale” and were “routinely collected
in the region of Québec among 5-year-old children attending
kindergarten during 1993-2004.”

La Capitale Nationale refers to
Quebec City,
located 265 kilometers from Montreal. Ms. Bouliane confirmed
that the MMR vaccination rates were indeed from the Quebec City
area but refused to release them to me because they were
administrative internal information only intended for research.

There are several published
vaccine uptake surveys of Montreal. MMR vaccination rates of children
24 to 30 month-old in the Montreal area increased from 85.1% in 1983
(Baumgarten) (2) to 88.8% in 1996-97 (Valiquette) (3) to 96% in
2003-04 (Health Department Survey) (4).

The above suggests that in
Montreal PDD prevalence and MMR vaccination rates were in fact
increasing in tandem during the study period.

The readers deserve to know why
the authors compared developmental data from a specific group of
children in Montreal with MMR vaccination data from the city of
Quebec, some distance away.

Conflict
of Interest: The
author is the grandfather of a child with autistic enterocolitis who
has evidence of measles virus genomic RNA in the gut.

***

I
received the following response:

20-Feb-2007

Title:
Far-Fetched
Manuscript number: 2007-0326

Dear
Dr.
F. Yazbak :

What
follows
is a copy of Dr. Fombonne's e-mail in response to your
Letter-to-the-Editor.

"This
person
is known to pursue the MMR-autism agenda at all costs in order
to 'demonstrate' a link he strongly believes in. The only way
ahead is to encourage him to do independent research. All
controlled epidemiological research thus far has concluded to the
absence of such a link."

As
a
note, I believe the evidence of no link between MMR and Autism is
sufficient. It's not worth publishing more on this subject.
We will not be publishing this exchange of correspondence.

Thank
you
for thinking of Pediatrics.

Sincerely,

Jerold
F.
Lucey, MD
Editor
Pediatrics Editorial Office

***

The
first sentence in Dr. Fombonne’s note is correct. I do
believe that a link does exist between MMR vaccination and autism in
certain genetically-predisposed children.

The
rest of the message is inappropriate both in tone and content and Dr.
Fombonne’s statement that “all controlled epidemiological
research thus far has concluded to the absence of such a link"
is irrelevant and unrelated to my letter.

So
is the editor’s personal belief about the “link between MMR and
Autism”.

I
found and reported a glaring error in the paper. The rates of
autism in Montreal have as much to do with MMR vaccination rates in
Quebec City as pollution in Los Angeles with Diesel buses in Chicago.

The
lead author refused to respond to my criticism concerning that simple
geographic fact and the editor was unable to force him to do so.

It
is as simple as that.

Furthermore,
in order to “estimate the pervasive developmental disorder
prevalence in Montreal”, Dr. Fombonne only surveyed children
enrolled in one
of Montreal’s five school boards.

In
2003-2004, that particular English school board only had 14% of all
total school boards enrollments in Montreal. In addition, this
board was never representative of the true student demographic
profile of the city, whose mother tongue is mostly French (43%),
followed by various non-English languages (37%) and then English
(22%). French and immigrant children who constitute the
majority of the school population cannot attend English schools.

My
submission to the electronic peer to peer review of PEDIATRICS,
also a first, was not published as well.

***

In
2001, Dr. Fombonne reported in PEDIATRICS the results of another
study that he had conducted in the United Kingdom. That
publication titled “No evidence for a new variant of
measles-mumps-rubella-induced autism” (1) was intended to rebuke
Andrew Wakefield’s theory. It received little or no
attention.

It
is not known how many relevant letters to the editor were rejected at
the time.

Discussing
the 2001 study in their comprehensive Cochrane MMR Review,
Demichelli, Jefferson et al reported that, “The numbers and
possible impact of biases in this study is so high that
interpretation of the results is impossible.” (2)

***

When
he was in France, Dr. Fombonne was a well known psychiatrist who
published articles on psychiatric topics. He was still a
psychiatrist when he moved to England …until Andrew Wakefield
suggested that the link between MMR vaccination and autism should be
further investigated and suddenly… Dr. Fombonne became a
“psychiatrist / epidemiologist” and a consultant to the UK
medical authorities on MMR vaccination and autism. He published
several articles on the subject including, “No evidence for a new
variant of measles-mumps-rubella-induced autism” in PEDIATRICS
in 2001 (above) but avoided
dealing with the Thimerosal issue.

Since
his arrival to Montreal, Dr. Fombonne is Chair, Department of
Psychiatry and Head of the Division of Child Psychiatry at McGill
University. He is also the Director of the Department of
Psychiatry at the Montreal Children’s Hospital, yet the lay press
often refers to him as an “Epidemiologist”.

Dr.
Fombonne was also recognized as an “Epidemiologist” in a
Thimerosal-related case in a U.S. Court.

A
footnote in the July 2006 publication, “Pervasive developmental
disorders in Montreal, Quebec, Canada: prevalence and links with
immunizations” reads: “In the United Kingdom, Dr Fombonne has
provided advice on the epidemiology and clinical aspects of autism to
scientists advising parents, to vaccine manufacturers, and to several
government committees between 1998 and 2001. Since June 2004,
Dr. Fombonne has been an expert witness for vaccine manufacturers in
US thimerosal litigation. None of his research has ever been
funded by the industry.”

It
is obviously customary to disclose sources of funding.
Disclosing sources of “Non-Funding” on the other hand is
unusual. In any case, it is nice to know that Dr. Fombonne’s
research was never funded by the “Industry”.

The
statement proves what I mentioned earlier: That Dr. Fombonne only
became interested in MMR vaccination in the UK after Andrew Wakefield
published his original research on the subject in 1998. It also
raises an important question: How did Dr. Fombonne become an “expert
witness for vaccine manufacturers” in 2004 when his very first
research on Thimerosal was just published in PEDIATRICS
on July 6, 2006?

No
wonder, “Pervasive developmental disorders in Montreal, Quebec,
Canada: prevalence and links with immunizations” was so important
to “protect” and it is no surprise that Dr. Fombonne chose not to
respond to my letter. Besides, what could he have said and how
could he have justified the strange fact that he compared
developmental information about a specific group of children in
Montreal with unrelated MMR vaccination data from Quebec City, a good
distance away?

"I know of no safe depository of the ultimate powers of the society but the people themselves, and if we think them not enlightened enough to exercise control with a wholesome discretion, the remedy is not to take it from them, but to inform their discretion by education."

-- Thomas Jefferson, letter to William C. Jarvis, September 28, 1820

“A sacred cow will not protect the herd.”

-- Sandy Gottstein

"What's the point of vaccination if it doesn't protect you from the unvaccinated?"

-- Sandy Gottstein

"Who gets to decide what the greater good is and how many will be sacrificed to it?"